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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">nViremia and drug resistance among HIV-1 patients on antiretroviral treatment – a cross-sectional study in Soweto, South Africa</title>
<author><name sortKey="El Khatib, Ziad" sort="El Khatib, Ziad" uniqKey="El Khatib Z" first="Ziad" last="El-Khatib">Ziad El-Khatib</name>
<affiliation><nlm:aff id="A1">Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A2">AIDS Virus Research Unit, National Institute for Communicable Diseases (NICD), Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Ekstrom, Anna Mia" sort="Ekstrom, Anna Mia" uniqKey="Ekstrom A" first="Anna Mia" last="Ekström">Anna Mia Ekström</name>
<affiliation><nlm:aff id="A1">Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Ledwaba, Johanna" sort="Ledwaba, Johanna" uniqKey="Ledwaba J" first="Johanna" last="Ledwaba">Johanna Ledwaba</name>
<affiliation><nlm:aff id="A2">AIDS Virus Research Unit, National Institute for Communicable Diseases (NICD), Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Mohapi, Lerato" sort="Mohapi, Lerato" uniqKey="Mohapi L" first="Lerato" last="Mohapi">Lerato Mohapi</name>
<affiliation><nlm:aff id="A3">Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Soweto, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Laher, Fatima" sort="Laher, Fatima" uniqKey="Laher F" first="Fatima" last="Laher">Fatima Laher</name>
<affiliation><nlm:aff id="A3">Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Soweto, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Karstaedt, Alan" sort="Karstaedt, Alan" uniqKey="Karstaedt A" first="Alan" last="Karstaedt">Alan Karstaedt</name>
<affiliation><nlm:aff id="A4">Division of Infectious Diseases, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Charalambous, Salome" sort="Charalambous, Salome" uniqKey="Charalambous S" first="Salome" last="Charalambous">Salome Charalambous</name>
<affiliation><nlm:aff id="A5">Aurum Institute for Health, Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Petzold, Max" sort="Petzold, Max" uniqKey="Petzold M" first="Max" last="Petzold">Max Petzold</name>
<affiliation><nlm:aff id="A1">Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A6">Nordic School of Public Health (NHV), Gothenburg, Sweden</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Katzenstein, David" sort="Katzenstein, David" uniqKey="Katzenstein D" first="David" last="Katzenstein">David Katzenstein</name>
<affiliation><nlm:aff id="A7">Division of Infectious Diseases, Stanford University, California, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Morris, Lynn" sort="Morris, Lynn" uniqKey="Morris L" first="Lynn" last="Morris">Lynn Morris</name>
<affiliation><nlm:aff id="A2">AIDS Virus Research Unit, National Institute for Communicable Diseases (NICD), Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PMC</idno>
<idno type="pmid">20453629</idno>
<idno type="pmc">2894994</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894994</idno>
<idno type="RBID">PMC:2894994</idno>
<idno type="doi">10.1097/QAD.0b013e32833a097b</idno>
<date when="2010">2010</date>
<idno type="wicri:Area/Pmc/Corpus">001080</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001080</idno>
</publicationStmt>
<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">nViremia and drug resistance among HIV-1 patients on antiretroviral treatment – a cross-sectional study in Soweto, South Africa</title>
<author><name sortKey="El Khatib, Ziad" sort="El Khatib, Ziad" uniqKey="El Khatib Z" first="Ziad" last="El-Khatib">Ziad El-Khatib</name>
<affiliation><nlm:aff id="A1">Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A2">AIDS Virus Research Unit, National Institute for Communicable Diseases (NICD), Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Ekstrom, Anna Mia" sort="Ekstrom, Anna Mia" uniqKey="Ekstrom A" first="Anna Mia" last="Ekström">Anna Mia Ekström</name>
<affiliation><nlm:aff id="A1">Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Ledwaba, Johanna" sort="Ledwaba, Johanna" uniqKey="Ledwaba J" first="Johanna" last="Ledwaba">Johanna Ledwaba</name>
<affiliation><nlm:aff id="A2">AIDS Virus Research Unit, National Institute for Communicable Diseases (NICD), Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Mohapi, Lerato" sort="Mohapi, Lerato" uniqKey="Mohapi L" first="Lerato" last="Mohapi">Lerato Mohapi</name>
<affiliation><nlm:aff id="A3">Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Soweto, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Laher, Fatima" sort="Laher, Fatima" uniqKey="Laher F" first="Fatima" last="Laher">Fatima Laher</name>
<affiliation><nlm:aff id="A3">Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Soweto, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Karstaedt, Alan" sort="Karstaedt, Alan" uniqKey="Karstaedt A" first="Alan" last="Karstaedt">Alan Karstaedt</name>
<affiliation><nlm:aff id="A4">Division of Infectious Diseases, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Charalambous, Salome" sort="Charalambous, Salome" uniqKey="Charalambous S" first="Salome" last="Charalambous">Salome Charalambous</name>
<affiliation><nlm:aff id="A5">Aurum Institute for Health, Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Petzold, Max" sort="Petzold, Max" uniqKey="Petzold M" first="Max" last="Petzold">Max Petzold</name>
<affiliation><nlm:aff id="A1">Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A6">Nordic School of Public Health (NHV), Gothenburg, Sweden</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Katzenstein, David" sort="Katzenstein, David" uniqKey="Katzenstein D" first="David" last="Katzenstein">David Katzenstein</name>
<affiliation><nlm:aff id="A7">Division of Infectious Diseases, Stanford University, California, USA</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Morris, Lynn" sort="Morris, Lynn" uniqKey="Morris L" first="Lynn" last="Morris">Lynn Morris</name>
<affiliation><nlm:aff id="A2">AIDS Virus Research Unit, National Institute for Communicable Diseases (NICD), Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
</analytic>
<series><title level="j">AIDS (London, England)</title>
<idno type="ISSN">0269-9370</idno>
<idno type="eISSN">1473-5571</idno>
<imprint><date when="2010">2010</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background:</title>
<p id="P3">We assessed risk factors for viremia and drug resistance (DR) among long-term recipients of antiretroviral therapy (ART) in South Africa.</p>
</sec>
<sec id="S2"><title>Methods:</title>
<p id="P4">In 2008, we conducted a cross-sectional study among patients receiving ART for ≥12 months. Genotypic resistance testing was performed on individuals with a viral load >400 RNA copies/ml. Multiple logistic regression analysis was used to assess associations.</p>
</sec>
<sec id="S3"><title>Results:</title>
<p id="P5">Of 998 subjects, 75% were women with a median age of 41. Most (64%) had been on treatment for >3 years. The prevalence of viremia was 14% (n=139); 12% (102/883) on first-line (i.e. NNRTI based regimen) and 33% (37/115) on second-line (i.e. PI based regimen) ART. Of viremic patients, 78% had DR mutations. For NRTIs, NNRTIs and PIs the prevalence of mutations was 64%, 81% and 2% among first-line and 29%, 54% and 6% among second-line failures respectively. M184V/I, K103N and V106A/M were the most common mutations.</p>
<p id="P6">Significant risk factors associated with viremia on first-line included concurrent tuberculosis treatment (OR 6.4, 2.2-18.8, p<0.01) and a recent history of poor adherence (OR 2.7, 1.3-5.6, p=0.01). Among second-line failures, attending a public clinic (OR 4.6, 1.8-11.3, p<0.01) and not having a refrigerator at home (OR 6.7, 1.2-37.5, p=0.03) were risk factors for virological failure.</p>
</sec>
<sec id="S4"><title>Conclusions:</title>
<p id="P7">Risk factors for viral failure were line-regimen dependent. Second-line ART recipients had a higher rate of viremia, albeit with infrequent PI DR mutations. Measures to maintain effective virologic suppression should include increased adherence counseling, attention to concomitant tuberculosis treatment and heat-stable formulations of second-line ART regimens.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article" xml:lang="EN"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">8710219</journal-id>
<journal-id journal-id-type="pubmed-jr-id">1493</journal-id>
<journal-id journal-id-type="nlm-ta">AIDS</journal-id>
<journal-title>AIDS (London, England)</journal-title>
<issn pub-type="ppub">0269-9370</issn>
<issn pub-type="epub">1473-5571</issn>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">20453629</article-id>
<article-id pub-id-type="pmc">2894994</article-id>
<article-id pub-id-type="doi">10.1097/QAD.0b013e32833a097b</article-id>
<article-id pub-id-type="manuscript">NIHMS198948</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>nViremia and drug resistance among HIV-1 patients on antiretroviral treatment – a cross-sectional study in Soweto, South Africa</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>El-Khatib</surname>
<given-names>Ziad</given-names>
</name>
<degrees>BSc, MSc</degrees>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A2">2</xref>
<xref ref-type="corresp" rid="CR1">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ekström</surname>
<given-names>Anna Mia</given-names>
</name>
<degrees>MD, MPH, PhD</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ledwaba</surname>
<given-names>Johanna</given-names>
</name>
<degrees>BSc, MSc</degrees>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mohapi</surname>
<given-names>Lerato</given-names>
</name>
<degrees>MBBCh</degrees>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Laher</surname>
<given-names>Fatima</given-names>
</name>
<degrees>MBBCh</degrees>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Karstaedt</surname>
<given-names>Alan</given-names>
</name>
<degrees>MBBCh</degrees>
<xref ref-type="aff" rid="A4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Charalambous</surname>
<given-names>Salome</given-names>
</name>
<degrees>MBBCh, MSc</degrees>
<xref ref-type="aff" rid="A5">5</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Petzold</surname>
<given-names>Max</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A6">6</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Katzenstein</surname>
<given-names>David</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A7">7</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Morris</surname>
<given-names>Lynn</given-names>
</name>
<degrees>DPhil</degrees>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>1</label>
Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden</aff>
<aff id="A2"><label>2</label>
AIDS Virus Research Unit, National Institute for Communicable Diseases (NICD), Johannesburg, South Africa</aff>
<aff id="A3"><label>3</label>
Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Soweto, South Africa</aff>
<aff id="A4"><label>4</label>
Division of Infectious Diseases, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa</aff>
<aff id="A5"><label>5</label>
Aurum Institute for Health, Johannesburg, South Africa</aff>
<aff id="A6"><label>6</label>
Nordic School of Public Health (NHV), Gothenburg, Sweden</aff>
<aff id="A7"><label>7</label>
Division of Infectious Diseases, Stanford University, California, USA</aff>
<author-notes><corresp id="CR1"><label>*</label>
<bold>Corresponding authors' mailing addresses:</bold>
Ziad El-Khatib, Division of Global Health (IHCAR), Nobelsv. 9; Karolinska Institutet; SE-171 77 Stockholm, Sweden, Phone: +46-73-776-4859; Fax: +46-8-311590, <email>ziad.el-khatib@ki.se</email>
</corresp>
<fn id="FN3"><p id="P1">AUTHORS' CONTRIBUTIONS</p>
<p id="P2">Ziad El-Khatib (ZEK), Anna Mia Ekström (AME), Lerato Mohapi (LMi), Fatima Laher (FL), Alan Karstaedt (AK), Salome Charalambous (SC), Max Petzold (MP), David Katzenstein (DK) and Lynn Morris (LM) participated in the study design and ethics. Johanna Ledwaba (JL) did the genotyping and sequence analysis. ZEK, FL, AK, DK and LM participated in the study piloting and data collection. ZEK worked on the data analysis and the first manuscript. All authors participated in reviewing and commenting on the manuscript.</p>
</fn>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>3</day>
<month>6</month>
<year>2010</year>
</pub-date>
<pub-date pub-type="ppub"><day>17</day>
<month>7</month>
<year>2010</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>17</day>
<month>7</month>
<year>2011</year>
</pub-date>
<volume>24</volume>
<issue>11</issue>
<fpage>1679</fpage>
<lpage>1687</lpage>
<abstract><sec id="S1"><title>Background:</title>
<p id="P3">We assessed risk factors for viremia and drug resistance (DR) among long-term recipients of antiretroviral therapy (ART) in South Africa.</p>
</sec>
<sec id="S2"><title>Methods:</title>
<p id="P4">In 2008, we conducted a cross-sectional study among patients receiving ART for ≥12 months. Genotypic resistance testing was performed on individuals with a viral load >400 RNA copies/ml. Multiple logistic regression analysis was used to assess associations.</p>
</sec>
<sec id="S3"><title>Results:</title>
<p id="P5">Of 998 subjects, 75% were women with a median age of 41. Most (64%) had been on treatment for >3 years. The prevalence of viremia was 14% (n=139); 12% (102/883) on first-line (i.e. NNRTI based regimen) and 33% (37/115) on second-line (i.e. PI based regimen) ART. Of viremic patients, 78% had DR mutations. For NRTIs, NNRTIs and PIs the prevalence of mutations was 64%, 81% and 2% among first-line and 29%, 54% and 6% among second-line failures respectively. M184V/I, K103N and V106A/M were the most common mutations.</p>
<p id="P6">Significant risk factors associated with viremia on first-line included concurrent tuberculosis treatment (OR 6.4, 2.2-18.8, p<0.01) and a recent history of poor adherence (OR 2.7, 1.3-5.6, p=0.01). Among second-line failures, attending a public clinic (OR 4.6, 1.8-11.3, p<0.01) and not having a refrigerator at home (OR 6.7, 1.2-37.5, p=0.03) were risk factors for virological failure.</p>
</sec>
<sec id="S4"><title>Conclusions:</title>
<p id="P7">Risk factors for viral failure were line-regimen dependent. Second-line ART recipients had a higher rate of viremia, albeit with infrequent PI DR mutations. Measures to maintain effective virologic suppression should include increased adherence counseling, attention to concomitant tuberculosis treatment and heat-stable formulations of second-line ART regimens.</p>
</sec>
</abstract>
<kwd-group><kwd>Antiretroviral therapy</kwd>
<kwd>HIV</kwd>
<kwd>adherence</kwd>
<kwd>HIV drug resistance</kwd>
<kwd>South Africa</kwd>
<kwd>Viral failure</kwd>
</kwd-group>
<contract-num rid="TW1">U2R TW006878-01A1
||TW</contract-num>
<contract-sponsor id="TW1">Fogarty International Center : FIC</contract-sponsor>
</article-meta>
</front>
</pmc>
</record>
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